Severe acute respiratory syndrome in children

BACKGROUND: Severe acute respiratory syndrome (SARS) is a febrile, respiratory tract illness caused by infection with the newly identified SARS-associated coronavirus. A notable feature of the 2003 global SARS outbreak was the relative paucity of cases reported among children. We reviewed the epidemiologic and clinical features of SARS in children and discuss implications of these findings for diagnosis, treatment and prevention of SARS. METHODS: We performed a literature search to identify reports of pediatric (younger than 18 years of age) patients meeting the World Health Organization case definitions for SARS and abstracted relevant clinical and epidemiologic information. RESULTS: We identified 6 case series reporting 135 pediatric SARS patients (80 laboratory-confirmed, 27 probable and 28 suspect) from Canada, Hong Kong, Taiwan and Singapore. Among laboratory-confirmed and probable SARS cases, the most common symptoms included fever (98%), cough (60%) and nausea or vomiting (41%); 97% had radiographic abnormalities. The clinical presentation of SARS in patients older than 12 years of age was similar to that in adults. However, patients 12 years of age or younger had milder disease and were less likely than older children to be admitted to an intensive care unit, receive supplemental oxygen or be treated with methylprednisolone. No deaths were reported among children or adolescents with SARS, and at 6 months after illness only mild residual changes were reported in exercise tolerance and pulmonary function. There is only 1 published report of transmission of SARS virus from a pediatric patient. CONCLUSIONS: Children and adolescents are susceptible to SARS-associated coronavirus infection, although the clinical course and outcome are more favorable in children younger than 12 years of age compared with adolescents and adults. Transmission of SARS from pediatric patients appears to be uncommon but is possible.     

SARS in newborns and children

The severe acute respiratory syndrome (SARS) is a highly contagious infection caused by a newly discovered strain of coronavirus (SARS-CoV). Infants born to pregnant women with SARS did not appear to acquire the infection through vertical transmission. Some newborn infants, however, developed severe intrauterine growth retardation and life-threatening gastrointestinal complications. It is now known that the clinical course and prognosis are different between paediatric and adult SARS patients. Young children (< 12 years), in general, run a less aggressive clinical course than do teenage and adult patients. Thus far, no fatalities have been reported in the paediatric age group (< or =18 years). This review describes the current understanding of the clinical manifestations, diagnostic tests, immunological profiles, patient management and outcomes of SARS-CoV infection in the paediatric population.     

Adolescent twin sisters with severe acute respiratory syndrome (SARS)

A novel coronavirus-associated communicable respiratory disease, severe acute respiratory syndrome (SARS), spread worldwide after an outbreak in Guangdong Province of the People's Republic of China in November 2002. Since late February 2003, there has been an epidemic in Hong Kong involving both adult and pediatric patients. The clinical course, intensive care, and outcome of adolescent twin sisters with SARS are described. Adolescents infected with SARS may develop severe illness as adults, and close monitoring for disease progression in terms of both clinical and radiologic deterioration is warranted.     

Severe acute respiratory syndrome (SARS)

Several cases of life threatening respiratory disease with no identifiable cause were reported from Guangdong Province, China; these were soon followed by reports from many other countries. The disease was named as severe acute respiratory syndrome (SARS). A novel coronavirus, isolated from the respiratory secretions of patients, has been implicated in the causation of SARS. The modes of transmission include droplet spread, close contact, and Fomites; shedding of virus from respiratory tract is the primary mode of transmission. SARS clinically presents with high-grade fever, chills and rigors, myalgia, headache, cough with or without sputum production, dyspnea, and dizziness. Chest radiographs reveal unilateral or bilateral, predominantly peripheral, areas of consolidation progressing with in a short time of bilateral patchy consolidation. Preliminary reports suggest a milder illness in young children. The case definition of probable SARS cases, laboratory investigations and precautions for prevention of spread are discussed.     

Severe acute respiratory syndrome (SARS) in children: epidemiology, presentation and management

Severe acute respiratory syndrome (SARS) is a newly recognised and highly contagious respiratory infection caused by a new strain of coronavirus. The disease can result in progressive respiratory failure in adults and the mortality rate has been reported to be 8-15%. This infection spreads by droplet transmission and children appear to acquire SARS through close household contact exposure to infected adults. Disease severity is, however, much milder in the paediatric age group. The common laboratory findings in infected children and adolescents include lymphopaenia and elevated levels of lactate dehydrogenase and creatinine phosphokinase. Air space consolidation is commonly seen during the course of the illness although chest radiographs are normal on presentation in half of the cases. The pathophysiology of SARS appears to be related to immunological dysregulation in response to the coronavirus infection. The optimal treatment of SARS in children remains to be determined. No case fatality in infected children has been reported. The early and proper isolation of infected adults, meticulous infection control measures in the hospital setting, exhaustive contact tracing and quarantine measures are important steps in preventing the spread of the disease among health care workers and into the community. The development of a sensitive and rapid test for early diagnosis is underway. Further controlled trials are necessary to define the optimal treatment of this infection in children.     

Diarrhoea as the presenting sign in an adolescent suffering from severe acute respiratory syndrome

Patients with severe acute respiratory syndrome (SARS) may present with extra-pulmonary symptoms. We report a 16-year-old adolescent with SARS who presented with diarrhoea. Treatment directed against SARS was prompted by an epidemiological link and the clinical picture as the disease evolved. This atypical presentation posed a diagnostic challenge for physicians. Conclusion:Proper disposal of patient excreta is important to prevent the spread of severe acute respiratory syndrome.     

The use of inhaled glucocorticosteroids and recovery from adrenal suppression after systemic steroid use in a VLBW premature infant with BPD: case report and literature discussion

Despite development of many prevention and treatment modalities for bronchopulmonary dysplasia (BPD), a form of chronic respiratory insufficiency in premature infants recovering from respiratory distress syndrome, BPD remains a treatment challenge and a significant cause of long-term morbidity. A ventilator-dependent very low birth weight infant in our newborn special care unit was receiving multiple courses of systemic dexamethasone for severe respiratory failure. The infant demonstrated adrenal suppression manifested by a baseline cortisol concentration below reported levels in infants of similar birth weight and postnatal age. We hypothesized that he had developed adrenal insufficiency as a result of the prolonged systemic steroid administration used to treat his respiratory problems. We further hypothesized that inhaled beclomethasone therapy would aid in the infant's recovery phase during relative adrenal insufficiency--and so substituted inhaled for systemic steroids. Inhaled corticosteroid treatment improved the clinical respiratory course and postnatal growth of this premature infant with BPD without inhibiting his recovery from adrenal insufficiency.     

Long-term sequelae of SARS in children

Severe acute respiratory syndrome (SARS) runs a more benign course in children during the acute phase. Unlike adult patients, no fatalities were reported among the paediatric SARS patients. Published data on long-term sequelae of SARS are very limited. In our follow-up study, although patients have clinically recovered from their initial illness, exercise impairment and residual radiological abnormalities were demonstrated at 6 months after diagnosis. It is important to assess these patients on a regular basis to detect and provide appropriate management for persistent or emerging long-term sequelae in the physical, psychological and social domains.     

Spontaneous bilateral pneumothorax in an infant with bronchiolitis

Spontaneous pneumothorax is an uncommon complication of bronchiolitis due to respiratory syncytial virus. Bilateral spontaneous pneumothorax in an infant with respiratory syncytial virus bronchiolitis has not been previously reported. We report the case of a four-month-old infant who presented in respiratory distress owing to respiratory syncytial virus bronchiolitis with bilateral pneumothoraces. The infant improved with evacuation of air from the chest.     

Severe acute respiratory syndrome can be mild in children

A 13-year-old boy contracted severe acute respiratory syndrome (SARS). The clinical course was mild, and no specific treatment was given. His recovery was spontaneous and complete. SARS in children can be a mild and self-limiting disease. The use of the World Health Organization/Centers for Disease Control and Prevention case definitions may not be adequate for the diagnosis of SARS in children.     

SARS‐CoV‐2 and human milk: What is the evidence?

The novel coronavirus SARS‐CoV‐2 has emerged as one of the most compelling and concerning public health challenges of our time. To address the myriad issues generated by this pandemic, an interdisciplinary breadth of research, clinical and public health communities has rapidly engaged to collectively find answers and solutions. One area of active inquiry is understanding the mode(s) of SARS‐CoV‐2 transmission. Although respiratory droplets are a known mechanism of transmission, other mechanisms are likely. Of particular importance to global health is the possibility of vertical transmission from infected mothers to infants through breastfeeding or consumption of human milk. However, there is limited published literature related to vertical transmission of any human coronaviruses (including SARS‐CoV‐2) via human milk and/or breastfeeding. Results of the literature search reported here (finalized on 17 April 2020) revealed a single study providing some evidence of vertical transmission of human coronavirus 229E; a single study evaluating presence of SARS‐CoV in human milk (it was negative); and no published data on MERS‐CoV and human milk. We identified 13 studies reporting human milk tested for SARS‐CoV‐2; one study (a non‐peer‐reviewed preprint) detected the virus in one milk sample, and another study detected SARS‐CoV‐2 specific IgG in milk. Importantly, none of the studies on coronaviruses and human milk report validation of their collection and analytical methods for use in human milk. These reports are evaluated here, and their implications related to the possibility of vertical transmission of coronaviruses (in particular, SARS‐CoV‐2) during breastfeeding are discussed.     

Childhood severe acute respiratory syndrome, coronavirus infections and asthma

Severe acute respiratory syndrome (SARS) is a new infectious disease caused by a novel coronavirus. Children appear to be less susceptible to the SARS coronavirus, although the other non-SARS coronaviruses can cause respiratory infections in adults and in children of all ages. The exact reasons as to why SARS preferentially affects adults, and not children, are still unknown. Many hypotheses exist and need to be explored. During the outbreak of SARS, there did not appear to be an increase in asthma exacerbations in children.     

Bird flu: lessons from SARS

Severe acute respiratory syndrome (SARS) and avian influenza are two important newly emerged infections with pandemic potential. Both infections have crossed the species barrier to infect humans. SARS originated from southern China and spread to many countries in early 2003. The close collaboration of scientists around the world resulted in a rapid identification of the causative agent, and the early isolation of infected cases and meticulous infection control measures were the key to successfully controlling the outbreak of SARS. The first outbreak of human cases of avian influenza was reported in 1997 in Hong Kong. Since 2003, there have been many small outbreaks of human cases around the world, and the reported mortality is greater than 50%. Current evidence suggests that the human-to-human transmission of avian influenza is rather inefficient, but mutation might occur in the future resulting in improved transmission and possibly a pandemic in humans. As with the outbreak of SARS, the development of sensitive and accurate early diagnostic tests is extremely important for successful control of the outbreak at source. The availability of isolation facilities, the stockpiling of antiviral agents and effective and safe vaccination will be extremely important in minimising the damage of a new influenza pandemic.     

Severe acute respiratory syndrome (SARS) in neonates and children

Severe acute respiratory syndrome (SARS) runs a more benign course in children during the acute phase. Infants born to mothers with the disease did not acquire the infection through vertical transmission. The treatment strategy for children with SARS has not been standardised and is based on adult experience. Thus far, no deaths have been reported in the paediatric age group. Exercise impairment and residual radiological abnormalities were present six months after diagnosis. It is important to assess these patients on a regular basis to detect and provide appropriate management for any persistent or emerging long term sequelae in the physical, psychological, and social domains. This review describes the current understanding of SARS coronavirus infection in newborns and children.     

基因检测在儿童严重急性呼吸综合征疑似病例诊断中的应用

目的 通过病原学检测鉴别诊断严重急性呼吸综合征(SARS)。方法 对1例没有明确SARS接触史,入院时临床诊断疑为“支原体肺炎”的患儿进行病原学鉴别诊断。(1)对患儿的咽拭子标本进行常见呼吸道病毒(包括呼吸道合胞病毒、甲、乙型流感病毒、腺病毒和I、Ⅱ、Ⅲ型副流感病毒)的抗原检测。(2)用RT-PCR进行人类偏肺病毒、肠道病毒和鼻病毒的检测。(3)采用巢式RT-PCR方法,进行SARS病毒基因检测。根据WHO在网上公布的SARS冠状病毒复制酶基因1b区合成3对引物,其中I对为所有冠状病毒所保守的,用来进行第一次PCR,另2对为SARS冠状病毒所特异的,分别用于第二次PCR,这2对引物可分别扩增368和348bp的基因片段。结果 患儿咽拭子标本7种常见呼吸道病毒和人类偏肺病毒、肠道病毒和鼻病毒的检测结果均为阴性,而用不同引物对检测,SARS冠状病毒基因均为阳性。经测序显示,该基因片段与GenBank已公布的17株SARS冠状病毒的序列同源性为100％,而与人冠状病毒的标准株有很低的同源性。同时该患儿的恢复期血清SARS冠状病毒特异性IgM和IgG均为阳性。结论 从患儿标本中未检测到常见的7种呼吸道病毒、人类偏肺病毒、肠道病毒和鼻病毒,而检测到了SARS冠状病毒。经病原学检测,确诊患儿为SARS,,在SARS流行期间,用检测常见呼吸道病毒抗原或基因的方法,可以将儿科的急性呼吸道病毒感染与SAPS进行区别。     

New interpretation and management of dry lung syndrome: A case report

A premature female infant with life-threatening respiratory distress which was diagnosed as ‘dry lung syndrome’ is reported. The mother had 4 weeks of large volume leakage of the amniotic fluid due to premature rupture of the fetal membranes (PROM) at 23 weeks' gestation. The infant was bom after 27 weeks' gestation (birthweight, 1016 g) and was suffering severe respiratory distress. Although a chest radiogram and gastric juice microbubble test did not prove the possibility of respiratory distress syndrome (RDS), very high ventilator settings did not improve her respiratory disorders. Considering the infant's deteriorating respiratory status and the prolonged leakage of the amniotic fluid, we suspected the presence of pulmonary hypoplasia. Although an attempt at high frequency oscillation (HFO) to rescue this infant had no effect, intratracheal instillation of epinephrine (EP) showed dramatic improvement of her respiratory status. This clinical course showed that the patient did not have pulmonary hypoplasia but might have severe airway obstruction and this airway obstruction may be the major cause of ‘dry lung syndrome’. We postulate that when a newborn with suspected pulmonary hypoplasia is unresponsive to respiratory support, HFO should be administered. If HFO is ineffective in relieving the respiratory distress, one should suspect the presence of airway collapse and administer a bronchodilator such as EP. If the infant improves, a diagnosis of ‘dry lung syndrome’ may be assumed.     

An uncommon cause of neonatal respiratory distress

We describe a term infant without any features of congenital infection, who presented with respiratory distress at birth. Respiratory distress persisted despite change of antibiotics, and chest radiography showed bilateral diffuse patchy infiltrates. Congenital infections screening obtained on the 10th day of life was reported positive for syphilis. The infant was started on penicillin G and came off oxygen within five days. Although the presentation of congenital syphilis as pneumonitis in the absence of other clinical signs is unusual, in view of the re-emergence of the disease, syphilitic involvement of the lungs should be considered in any infant presenting with persistent diffuse lung disease of unknown etiology.     

疑难病研究——我国首例先天性中枢性低通气综合征的诊治

报道我国首例先天性中枢性低通气综合症 (CCHS)患儿临床诊治情况。患儿胎龄 36周 ,生后第 1天即发病 ,整个临床过程表现为低通气并致高碳酸血症及低氧血症 ,经机械通气后血气迅速恢复正常 ,撤机或降低呼吸机参数后又出现异常血气 ,导致撤机困难。住院第 6天后发现患儿于醒觉期自主呼吸活动增强 ,睡眠期呼吸活动减弱且无呼吸增快 ,并伴体温波动 ,心律失常及胸骨上窝轻度吸气性凹陷 ,参照国外相关文献 ,最后确诊为CCHS ,并以机械通气治疗至住院第 1 4天家属放弃。